Missing in Action; and Missing the Action

Last week there were a number of places I should have been at, people I should have seen, conversations I should have had, and hands I should have held. It wasn’t a good week for me, and possibly, for others too. It was a week of poignancy and pain as well as some goodness. Last week was graduation week at the University of Salford. As long standing readers of this blog will know, when I was Head of School and then latterly a Dean, Graduation Day was both my nemesis and one of my greatest pleasures each year. It was always great to celebrate the success of our students, meet their family’s and wish them well on the next stage of their life journey.

This was me some 39 years ago (ringed in yellow) ‘graduating’ as a qualified nurse in Swansea. I was so proud to have survived the course, which unlike today, was not a graduate level programme. The ceremony back then was a very different affair from the graduation ceremonies that I have been part of over the last 11 years. I love being on the stage and the little boy in me likes dressing up. The pomp and tradition, the seriousness and celebration were tangible acknowledgements of the achievement every person gaining their degree has made. What I dreaded about the day was trying to pronounce the names of some of our students. I just found it so difficult to get my tongue around some of the pronunciations, despite hours of practice.

However, despite my tendency to mangle some people’s names, it always felt like a real honour to present the names of the students as they each received their award. My current role in the University has taken me away from this, and it is something I have really missed. Last year I had a kind of ‘walk on part’. As a member of the University Council I was asked to talk about the work of the Council and the Councils contribution to the future development of the University. It wasn’t quite the same. And this year I didn’t get to be part of any of the ceremonies at all.

Being part of celebration of the students success was a wonderful experience to share. But I guess inevitably, it was those students who I had the closest and most sustained relationship with that made my heart beat with pride for them at graduation. Most often these were my PhD students. This year 2 students, Duaa and Seham, both from Saudi Arabia, completed and were able to graduate. They had their struggles over their time with the University, but both eventually did very well. Seham, whose work looked at the stigmatising views and attitudes of mental health professionals held against the very people they should be caring for, was both courageous and powerful. She has already gained an influential position back in Saudi, and I am very confident that she will make a difference to their future mental health care services.

Due to poor timing, another of my students Ibrahim, also from Saudi, had his PhD viva last week, and got through with just minor corrections to attend to. I missed the viva and being there with him, a role carried out so well by my co-supervisor Celia. Ibrahim's work looked at the impact of total quality management approaches to the improvement of health services in Saudi. Again it was a very interesting piece of work that revealed the difficulties that many health service systems have in both measuring and improving the quality of care provided.

In the UK it is the Care Quality Commission (CQC) who are charged with both measuring the quality of care provided and recognising where services are outstanding or simply unacceptable. To me, the CQC have an almost impossible task, and arguably whilst some poor practices are picked up and addressed, the approach remains imprecise and challenged by the human element of the assessors. They are not my favourite group of people, and I say that from the qualified position of being on both sides of the quality assurance table.

I was reminded of this last week as my brother-in-law David became a patient at a local hospital – North Manchester General Hospital. In 2016, the CQC judged this hospital overall to be ‘inadequate’. This was a damming judgement of the services provided, see here for the full report. The reports ‘inadequate’ outcome prompted a neighbouring and ‘outstanding’ NHS Trust to take responsibility for bringing about improvement. The work is ongoing. One of the things I think the CQC often gets wrong, is that they miss the individual experience of patients. David’s care was exemplary. It was provided by knowledgeable health care professionals, who demonstrated their care in the most compassionate of ways. Yes there were issues (noise at night; ward transfers and so on) but overall he was treated as I would want to be treated. 

Sadly, after just a week of receiving treatment, David died in the early hours of Friday morning. I wasn’t there, but his wife and son were. They were treated with respect and dignity and when W got there shortly after his death, the nurses made the time to support and comfort the family. David was a larger than life man – in all senses of the word. He looked after his 2 sisters (Glenda and W) all his life, and his son and 2 grandchildren were the apple of his eye. The love of his life was his wife Jenny, someone he would have done anything for. David will be very much missed, and although his sudden and unexpected death is a great shock, I am glad at the end of his life he didn’t suffer, and proud that that the care he received from the NHS was absolutely outstanding.